Medicare and IVIG? in Dysautonomia Discussion Posted October 11, 2017 · Report reply A number of years ago I tried low dose naltrexone as was recommended by my then Rheumatologist. He said it might help sleep ( which is no longer an issue), pain and fatigue. I gave it 6 months. Three months of 3mg then three months of 4.5mg. It did absolutely nothing for me. I'm glad some people are receiving some benefits from it. A few years after that he recommended I try Nuvigil. It caused severe insomnia and greatly increased my already significant flu-like feelings so that med only worsened everything. A number of years later after being diagnosed with mod-severe OSA my Pulmonologist recommended I try Provigil ( modafinil ). I told him about my bad experience with Nuvigil but he said he didn't think I would experience those problems with Provigil so I decided to gave it a go. Unfortunately I did suffer the same side effects. Only to a lesser degree. I later read something somewhere that people with mast cell issues generally had problems with meds like Nuvigil and Provigil. I then asked my Pulmonologist about trying Adderall which I had read some sleep apnea and pots patients were being prescribed. He was agreeable to that. So at this point how do I manage my fatigue; I take 5 mg of Adderall maybe two to three times a week. I never take more then the 5mg, I rarely take it past lunch time and I rarely take it two days in a row because while it does allow me to do more I have to expect I will require a lot more rest the day after. I suppose it's a bit of a push/crash effect. It's not a perfect approach but I'm desperate and I feel I need to do something to gain a greater degree of function at least some of the time. For me doing this is a bit of a risk because of the labile b/p. My Neurologist tells me to be very careful with taking this med and I'm afraid to tell my Cardiologist. On a side note have you ever had a sleep study done ? In thinking back to how long I complained of severe fatigue among other things I still can't believe how long it took for someone to finally recommend a sleep study. I was really surprised at the results. Consistent use of my CPAP has helped my fatigue maybe 10 percent. Not what I had hoped for but I'll take what I can get. Some people I have spoken with say using a CPAP changed their life. I'm still trying to be hopeful that at some point the Imuran/IVIG combination therapy will improve my fatigue. I know how isolating having a chronic debilitating condition can be. I'm sorry you're dealing with this situation as well.